Removing the testicles (orchidectomy) | Cancer Research UK Removing the testicles (orchidectomy) Removing the testicles (orchidectomy) Find out about surgery to remove the testicles to treat prostate cancer. Prostate cancer needs testosterone to grow. Testosterone is the male sex hormone produced by the testicles. Removing the testicles helps control the growth of advanced prostate cancer. This is an orchidectomy, also called orchiectomy. After removal of the testicles, the level of testosterone in the blood falls quickly. Removing the testicles is not a common treatment. Hormone treatments are the main treatment to reduce the level of testosterone in your blood. Some men prefer to have this surgery as it is one treatment compared to regular injections. Orchidectomy is not reversible. You may find the removal of your testicles upsetting. What happens Removing the testicles is a simple operation. You have the operation as an inpatient in the hospital. Most men stay overnight, but you might be able to go home on the same day. Before the procedure You have an orchidectomy under general anaesthetic. You will be asleep for the whole operation. Some men have a spinal anaesthetic.

That means you are awake, but have an anaesthetic injection into your spine. You can’t feel anything below the level of the injection. Preparing for your operation During the procedure The surgeon makes a small cut in your scrotum (the sac which holds your testicles). After removing your testicles, your surgeon may put in fake testicles (prostheses) so that your scrotum looks and feels the same. You may be able to have a smaller operation to remove only the inner part of your testes. This is a subcapsular orchidectomy. You don’t need a prosthesis after this operation. After the procedure You may have some discomfort after the operation. You will have a few stitches on your scrotum. Usually, these are absorbable. So, they don’t need removal. You may go home the same day or stay in the hospital overnight. Possible risks Your doctors will make sure the benefits of having the surgery outweigh these possible risks: hot flushes erection problems Follow up You will have a follow up appointment 6 weeks or so after your surgery. At the appointment your doctor: examines you asks you about how you are and if you have had any problems It is also your chance to ask any questions.

Write down any questions you have before your appointment to help you remember what you want to ask. Taking someone with you can help you to remember what the doctor says. After your first check up you will continue to have follow up to monitor your cancer. How often you have checkups varies. Ask your doctor how often you need to have checkups and what they will involve. Last reviewed: EAU Guidelines on prostate cancer. 2015 N. Mottet and others Prostate cancer: diagnosis and management NICE guidelines [CG175] January 2014 Prostate cancer: Treatment. British Medical Journal (BMJ) Best Practice Online. June 2016 British Association of Urology Surgeons Orchidectomy March 2016 Orchiectomy - procedure, blood, removal, pain, time, infection, operation, medication Orchiectomy Orchiectomy Definition Orchiectomy is the surgical removal of one or both testicles, or testes, in the human male. It is also called an orchidectomy, particularly in British publications. The In an orchiectomy, the scrotum is cut open (A). Testicle covering is cut to expose the testis and spermatic cord (B).

The cord is tied and cut, removing the testis (C), and the wound is repaired (D). ( Illustration by GGS Inc. ) removal of both testicles is known as a bilateral orchiectomy, or castration, because the person is no longer able to reproduce. Emasculation is another word that is sometimes used for castration of a male. Castration in women is the surgical removal of both ovaries (bilateral oophorectomy ). Purpose An orchiectomy is done to treat cancer or, for other reasons, to lower the level of testosterone, the primary male sex hormone, in the body. Surgical removal of a testicle is the usual treatment if a tumor is found within the gland itself, but an orchiectomy may also be performed to treat prostate cancer or cancer of the male breast, as testosterone causes these cancers to grow and metastasize (spread to other parts of the body). An orchiectomy is sometimes done to prevent cancer when an undescended testicle is found in a patient who is beyond the age of puberty. A bilateral orchiectomy is commonly performed as one stage in male-to-female (MTF) gender reassignment surgery.

It is done both to lower the levels of male hormones in the patient's body and to prepare the genital area for later operations to construct a vagina and external female genitalia. Some European countries and four states in the United States (California, Florida, Montana, and Texas) allow convicted sex offenders to request surgical castration to help control their sexual urges. This option is considered controversial in some parts of the legal system. A small number of men with very strong sex drives request an orchiectomy for religious reasons; it should be noted, however, that official Roman Catholic teaching is opposed to the performance of castration for spiritual purity. Demographics Cancer Cancers in men vary widely in terms of both the numbers of men affected and the age groups most likely to be involved. Prostate cancer is the single most common malignancy affecting American men over the age of 50; about 220,000 cases are reported each year. According to the Centers for Disease Control and Prevention (CDC), 31,000 men in the United States die every year from prostate cancer. African-American men are almost 70% more likely to develop prostate cancer than either Caucasian or Asian-American men; the reasons for this difference are not yet known.

Other factors that increase a man's risk of developing prostate cancer include a diet high in red meat, fat, and dairy products, and a family history of the disease. Men whose father or brother(s) had prostate cancer are twice as likely as other men to develop the disease themselves. Today, however, there are still no genetic tests available for prostate cancer. Testicular cancer, on the other hand, frequently occurs in younger men; in fact, it is the most common cancer diagnosed in males between the ages of 15 and 34. The rate of new cases in the United States each year is about 3.7 per 100,000 people. The incidence of testicular cancer has been rising in the developed countries at a rate of about 2% per year since 1970. It is not yet known whether this increase is a simple reflection of improved diagnostic techniques or whether there are other causes. There is some variation among racial and ethnic groups, with men of Scandinavian background having higher than average rates of testicular cancer, and African-American men having a lower than average incidence.

Testicular cancer occurs most often in males in one of three age groups: boys 10 years old or younger; adult males between the ages of 20 and 40; and men over 60. Other risk factors for testicular cancer include: Cryptorchidism, which is a condition in which a boy's testicles do not move down from the abdomen into the scrotum at the usual point in fetal development. It is also called undescended testicle(s). Ordinarily, the testicles descend before the baby is born; however, if the baby is born prematurely, the scrotal sac may be empty at the time of delivery. About 3–4% of full-term male infants are born with undescended testicles. Men with a history of childhood cryptorchidism are three to 14 times more likely to develop testicular cancer. Family history of testicular cancer. A mother who took diethylstilbestrol (DES) during pregnancy. DES is a synthetic hormone that was prescribed for many women between 1938 and 1971 to prevent miscarriage. It has since been found to increase the risk of certain types of cancer in the offspring of these women.

Occupational and environmental factors. Separate groups of researchers in Germany and New Zealand reported in 2003 that firefighters have an elevated risk of testicular cancer compared to control subjects. The specific environmental trigger is not yet known. Gender reassignment Statistics for orchiectomies in connection with gender reassignment surgery are difficult to establish because most patients who have had this type of surgery prefer to keep it confidential. Persons undergoing the hormonal treatments and periods of real-life experience as members of the other sex that are required prior to genital surgery frequently report social rejection, job discrimination, and other negative consequences of their decision. Because of widespread social disapproval of surgical gender reassignment, researchers do not know the true prevalence of gender identity disorders in the general population. Early estimates were 1:37,000 males and 1:107,000 females. A recent study in the Netherlands, however, maintains that a more accurate estimation is 1:11,900 males and 1:30,400 females. In any case, the number of surgical procedures is lower than the number of patients diagnosed with gender identity disorders.

Description There are three basic types of orchiectomy: simple, subcapsular, and inguinal (or radical). The first two types are usually done under local or epidural anesthesia, and take about 30 minutes to perform. An inguinal orchiectomy is sometimes done under general anesthesia, and takes between 30 minutes and an hour to complete. Simple orchiectomy A simple orchiectomy is performed as part of gender reassignment surgery or as palliative treatment for advanced cancer of the prostate. The patient lies flat on an operating table with the penis taped against the abdomen. After the anesthetic has been given, the surgeon makes an incision in the midpoint of the scrotum and cuts through the underlying tissue. The surgeon removes the testicles and parts of the spermatic cord through the incision. The incision is closed with two layers of sutures and covered with a surgical dressing. If the patient desires, a prosthetic testicle can be inserted before the incision is closed to give the appearance of a normal scrotum from the outside. Subcapsular orchiectomy A subcapsular orchiectomy is also performed for treatment of prostate cancer.

The operation is similar to a simple orchiectomy, with the exception that the glandular tissue is removed from the lining of each testicle rather than the entire gland being removed. This type of orchiectomy is done primarily to keep the appearance of a normal scrotum. Inguinal orchiectomy An inguinal orchiectomy, which is sometimes called a radical orchiectomy, is done when testicular cancer is suspected. It may be either unilateral, involving only one testicle, or bilateral. This procedure is called an inguinal orchiectomy because the surgeon makes the incision, which is about 3 in (7.6 cm) long, in the patient's groin area rather than directly into the scrotum. It is called a radical orchiectomy because the surgeon removes the entire spermatic cord as well as the testicle itself. The reason for this complete removal is that testicular cancers frequently spread from the spermatic cord into the lymph nodes near the kidneys. A long non-absorbable suture is left in the stump of the spermatic cord in case later surgery is necessary.

After the cord and testicle have been removed, the surgeon washes the area with saline solution and closes the various layers of tissues and skin with various types of sutures. The wound is then covered with sterile gauze and bandaged. Diagnosis/Preparation Surgery for Testicular Cancer Surgery for Testicular Cancer Surgery is typically the first treatment for all testicular cancers. Radical inguinal orchiectomy As described in the section “ How is testicular cancer diagnosed? ”, this type of surgery removes the testicle (or testicles) containing the cancer. An incision is made just above the pubic area, and the testicle is gently removed from the scrotum through the opening. A cut is made through the spermatic cord that attaches the testicle to the abdomen. The surgeon ties off the blood and lymph vessels in the spermatic cord early in the operation and takes other special precautions to avoid spreading cancer cells into the surgical wound or dislodging them from the tumor into the bloodstream. All testicular cancers are typically treated with this surgery, even those that have spread.

Retroperitoneal lymph node dissection (RPLND) Depending on the type and stage of your cancer, some lymph nodes at the back of the abdomen (around the large blood vessels known as the aorta and inferior vena cava) may also be removed at the same time as the orchiectomy or during a second operation. Not all patients with testicular cancer need to have lymph nodes removed, so it’s important to discuss this (and the possible alternatives) with your doctor. This is a complex and long operation. A large incision is typically made down the middle of the abdomen to remove the lymph nodes. It should be done by a surgeon who does this often. Experience counts. Laparoscopic surgery: In some cases, the surgeon can remove lymph nodes through very small skin incisions in the abdomen by using a laparoscope (a narrow, lighted tube with a small video camera on the end that lets doctors see inside the abdomen) and other long, thin surgical tools. The surgeon’s hands are not inside the patient’s body during this type of surgery. In laparoscopic surgery, after being put to sleep, the patient is turned onto his side. Several small incisions are made on the abdomen.

A laparoscope and long instruments are inserted through the incisions to remove the lymph nodes. The incisions are then closed and the patient is awakened. Patients recover much more quickly from this operation than the standard open procedure and are walking soon after surgery. There is usually less pain and patients are eating sooner. Laparoscopic surgery seems to be a lot easier for the patient, but doctors are not sure if it’s as safe and effective as the standard “open” surgery in removing all of the potentially cancerous lymph nodes. Because of this uncertainty, doctors are more likely to recommend chemotherapy after laparoscopic surgery if cancer is found in the lymph nodes. This procedure is most often used for patients with early stage non-seminomas to see if the lymph nodes contain cancer. As with the standard open procedure, this is a complex operation that should only be done if the surgeon is very experienced. Possible risks and side effects of surgery The short-term risks of any type of surgery include reactions to anesthesia, excess bleeding, blood clots, and infections. Most men will have at least some pain after the operation, which can usually be helped with pain medicines, if needed.

Effects of orchiectomy: Losing one testicle usually has no effect on a man’s ability to get an erection and have sex. But if both testicles are removed, sperm cells cannot be produced and a man becomes infertile. Also, without testicles, a man cannot make enough testosterone, which can decrease sex drive and affect his ability to have erections. Other effects could include fatigue, hot flashes, and loss of muscle mass. These side effects can be avoided by taking testosterone supplements, either in a gel, a patch, or a shot. Pills are generally not reliable sources of testosterone. Usually men with testicular cancer are young and may be concerned that their appearance has changed. They may be dating and worry about a partner’s reaction, or they may be athletic and feel embarrassed by the missing testicle when in locker rooms. To restore a more natural look, a man can have a testicular prosthesis surgically implanted in his scrotum. The prosthesis approved for use in the United States is filled with saline (salt water) and comes in different sizes to match the remaining testicle. When in place, it can look like a normal testicle.

There can be a scar after the operation, but it’s often partly hidden by pubic hair. Some men might want a prosthesis, while others might not. You should discuss your wishes with your surgeon before considering this surgery. It could also help to talk with someone who has a testicular prosthesis, to hear what it has been like for them. Effects of lymph node dissection: Surgery to remove retroperitoneal lymph nodes is a major operation. Serious complications are not common, but they can happen. About 5% to 10% of patients have temporary complications after surgery, such as bowel obstruction or wound infections. The standard approach for an RPLND requires a large incision in the abdomen, which will leave a scar and can take some time to heal. Your ability to get up and around after the operation will be limited for some time. This is less likely to be an issue if you have laparoscopic surgery, which uses smaller incisions. This type of surgery does not cause impotence – a man can still have erections and sexual intercourse. But it might damage some of the nerves that control ejaculation.

If these nerves are damaged, when a man ejaculates, the semen is not propelled forward through the urethra to exit the body but rather goes backwards into the bladder. This is known as retrograde ejaculation, and it can make it hard to father children. To save the normal ejaculation function, surgeons have developed a type of retroperitoneal lymph node surgery called nerve-sparing surgery that is very successful when done by experienced doctors. Testicular cancer often affects men at an age when they may be trying to have children. These men may wish to discuss nerve-sparing surgery with their doctors, as well as sperm banking (freezing and storing sperm cells obtained before treatment). Men with testicular cancer often have lower than normal sperm counts, which can sometimes make it hard to collect a good sperm sample. See Fertility and Men With Cancer to find out more about this. Types of surgery | Cancer Research UK You have the operation under either: a general anaesthetic (where you are unconscious) or a spinal anaesthetic (where you are awake but can't feel anything from the waist down) The operation normally takes about 30 minutes. The surgeon makes a cut in the groin and cuts the spermatic cord to remove the testicle.

They might also remove nearby lymph nodes and a small gland called the seminal vesicle. The surgeon sends the removed testicle to the laboratory for examination under a microscope. It takes a few days to get the results. Removing lymph nodes (retroperitoneal lymph node dissection) Lymph nodes form a network of glands throughout your body. Testicular cancer can spread to the lymph nodes and make them get bigger (enlarge). If you have non seminoma cancer and still have enlarged lymph nodes in your tummy (abdomen) after radiotherapy or chemotherapy, you might have an operation to remove them. This operation is called retroperitoneal lymph node dissection. What to expect You have this surgery under general anaesthetic. It can take between 3 and 7 hours. You may need to stop eating and drinking for a few hours beforehand. You may have a drip. More rarely, you might have surgery to remove lymph nodes in your chest. This operation is called a para aortic lymph node dissection. Removing secondary cancer in the lungs If testicular cancer has spread to your lung you might have surgery to remove it.

Your specialist may suggest this if: there is still a sign of cancer after chemotherapy the cancer is thought to be resistant to chemotherapy What to expect This is major surgery that you have under general anaesthetic. You have a drip into your vein and tubes coming out from your wound. Surgery to the chest always makes the lung collapse. You have a tube into your chest for a few days. The tube connects to a suction bottle. It helps your lung expand (inflate) again. The surgery might involve cutting through some ribs. This can be painful while it heals. This surgery can be done more than once if the tumours grow back again. This will depend on how fit you are and how much treatment you want to have.

Testicular seminoma and non seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up J Oldenburg and others Annals of Oncology, 2013, 24 (supplement 6 ): vi125-vi132 Comparative effectiveness of minimally invasive versus open lymphadenectomy in urological cancers SM Prasad, AL Shalhav Current Opinion in Urology, 2013 Jan;23(1):57-64 Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancer – a single center analysis J Busch and others Orchiectomy (Inpatient Care) - What You Need to Know Aftercare Instructions Discharge Care Inpatient Care Precare En Espanol WHAT YOU NEED TO KNOW: Orchiectomy, also called orchidectomy, is surgery to remove one or both of your testicles. Your testicles are egg-shaped organs that lie inside your scrotum. They are supported by your spermatic cord. WHILE YOU ARE HERE: Before your surgery: Informed consent is a legal document that explains the tests, treatments, or procedures that you may need.

Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered. An IV is a small tube placed in your vein that is used to give you medicine or liquids. Tests: Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV. Urine sample: A sample of your urine is collected and sent to a lab for tests. Pre-op care: You may be given medicine right before your surgery. This medicine may make you feel relaxed and sleepy. Anesthesia: This is medicine that will help keep you comfortable during your surgery. You may have any of the following: Local anesthesia: This is medicine that is given as a shot into your skin. It is used to numb the surgery area and dull your pain.

Spinal or epidural anesthesia: This is medicine put into your back to numb you below the waist. With spinal anesthesia, the medicine is given through an injection. Feeling normally returns in about 2 hours. Epidural anesthesia is put into your back through a tiny tube. After epidural anesthesia, feeling returns to your legs when the medicine wears off. General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up. Monitoring: Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity. A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. During your surgery: Your healthcare provider will make an incision in your scrotum. He ties your spermatic cord and cuts it just above your testicle. He may remove your whole testicle, or only parts of it.

A prosthetic (man-made) testicle may be put inside your scrotum. This allows your scrotum to look normal from the outside. A drain may be placed inside your skin to remove fluid from around your incision. Your incision will be closed with stitches and covered with a bandage. This will help keep the area clean and dry, and protect it from infection. If only one of your testicles is removed, your healthcare provider may do a biopsy on the remaining testicle. A biopsy is done by taking cells out through a needle. Your testicles and other removed tissues may be sent to a lab for tests. After your surgery: You may need to wear a jock strap for support after your surgery. You will be taken to a room where you will rest until you are fully awake. Healthcare providers will monitor you closely. Do not get out of bed until your healthcare provider says it is okay. When healthcare providers see that you are okay, you may be able to go home. If you are staying in the hospital, you will then be taken to your hospital room. Ice: Healthcare providers may instruct you to apply ice to your incision. Ice will help to decrease pain and swelling.

Medicines: Antihormone medicine: Antihormone medicine helps block the production of testosterone in your body and may slow tumor growth. Pain medicine: You may be given a prescription medicine to decrease pain. Do not wait until the pain is severe before you ask for more medicine. Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health. RISKS: You may bleed more than expected during surgery or get an infection. Blood may pool inside your scrotum. Your scrotum may swell and become painful after your surgery. If you have both testicles removed, you may have symptoms of decreased male hormone levels. Low male hormone levels may cause decreased sexual desire, erection problems, a smaller penis, and enlarged breasts. You may have weight gain, hot flashes, a dry mouth, and mood changes. Your bones may become weak, and you may have decreased muscle mass. Decreased male hormones may also make you unable to get your female partner pregnant. You may get a blood clot in your leg or arm.

The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke. Without surgery, your condition may worsen. If you have cancer or an infection, it may spread to other parts of your body. If you have a severe injury in your testicles, it may cause damage to nearby nerves and tissues. CARE AGREEMENT: You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. Testicular cancer - Treatment - NHS Choices Testicular cancer Chemotherapy, radiotherapy and surgery are the three main treatments for testicular cancer. Your recommended treatment plan will depend on: the stage of your testicular cancer The first treatment option for all cases of testicular cancer, whatever the stage, is to surgically remove the affected testicle (an orchidectomy). For stage one seminomas, after the testicle has been removed, a single dose of chemotherapy may be given to help prevent the cancer returning. A short course of radiotherapy is also sometimes recommended.

However, in many cases, the chance of recurrence is low and your doctors may recommend that you're very carefully monitored over the next few years. Further treatment is usually only needed for the small number of people who have a recurrence. For stage one non-seminomas, close follow-up (called surveillance) may also be recommended, or a short course of chemotherapy using a combination of different medications. For stage two, three and four testicular cancers, three to four cycles of chemotherapy are given using a combination of different medications. Further surgery is sometimes needed after chemotherapy to remove any affected lymph nodes or deposits in the lungs or, rarely, in the liver. Some people with stage two seminomas may be suitable for less intense treatment with radiotherapy, sometimes with the addition of a simpler form of chemotherapy. In non-seminoma germ cell tumours, additional surgery may also be required after chemotherapy to remove tumours from other parts of the body, depending on the extent of the spread of the tumour. Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours. Before discussing your treatment options with your specialist, you may find it useful to write a list of questions to ask them.

For example, you may want to find out the advantages and disadvantages of particular treatments. Orchidectomy An orchidectomy is a surgical procedure to remove a testicle. If you have testicular cancer, the whole of the affected testicle will need to be removed because only removing the tumour may lead to the cancer spreading. By removing the entire testicle, your chances of making a full recovery are greatly improved. Your sex life and ability to father children won't be affected. About one in 50 people will get a second new testicular cancer in their remaining testicle. In such circumstances, it's sometimes possible to only remove the part of the testicle containing the tumour. You should ask your surgeon about this if you're in this position. If testicular cancer is detected in its very early stages, an orchidectomy may be the only treatment you require. An orchidectomy isn't carried out through the scrotum. It's done by making an incision in your groin through which the testicle is removed with all of the tubes and blood vessels attached to the testicle that pass through the groin into the abdomen. The operation is carried out under general anaesthetic .

You can have an artificial (prosthetic) testicle inserted into your scrotum so that the appearance of your testicles isn't greatly affected. The artificial testicle is usually made of silicone (a soft type of plastic). It probably won't be exactly like your old testicle or the one you still have. It may be slightly different in size or texture. After an orchidectomy, it's often possible to be discharged quickly, although you may need to stay in hospital for a few days. If only one testicle is removed, there shouldn't be any lasting side effects. If both testicles are removed (a bi-lateral orchidectomy), you'll be infertile. However, removing both testicles at the same time is very rarely required, and only one in every 50 cases require the other testicle to be removed at a later date. You may be able to bank your sperm before having a bi-lateral orchidectomy to allow you to father children if you decide to. Sperm banking Most people are still fertile after having one testicle removed. However, some treatments for testicular cancer can cause infertility .

Some people with testicular cancer may have low sperm counts because of changes that occur in the testicles before the cancer develops. For some treatments, such as chemotherapy, infertility may occur, but standard chemotherapies have a less than 50% chance of causing infertility if the remaining testicle is normal. In people who need to have post-chemotherapy removal of lumps at the back of the abdomen, known as retroperitoneal lymph node dissection (RPLND) (see below), the ability to ejaculate (eject sperm from the penis) may be affected, even though the remaining testicle can still produce sperm. Before your treatment begins, you may want to consider sperm banking. This is where a sample of your sperm is frozen so that it can be used at a later date to impregnate your partner during artificial insemination . Before sperm banking, you may be asked to have tests for HIV , hepatitis B and hepatitis C . If you're having complex chemotherapy for stage two to four testicular cancer, you should always be offered sperm banking. Ask if you're concerned about your fertility. Not all men are suitable for sperm banking. For the technique to work, the sperm has to be of a reasonably high quality.

There may also be situations where it's considered too dangerous to delay treatment for sperm banking to take place. Most NHS cancer treatment centres offer a free sperm banking service. However, it's up to each area of the country to decide whether they store sperm for free of whether you have to pay. Cancer Research UK has more information about sperm banking , including the cost of sperm storage. Testosterone replacement therapy If you still have a remaining testicle, in most cases (90%) your body will make enough testosterone so you won't notice any difference. If there are any problems with your remaining testicle, you may experience symptoms due to a lack of testosterone. These symptoms can be caused for other reasons but can include: tiredness reduced beard growth reduced ability to achieve or maintain an erection ( erectile dysfunction ) Having both testicles removed will definitely stop you producing testosterone and you'll develop the above symptoms. Testosterone replacement therapy is where you're given testosterone in the form of an injection, skin patch or gel to rub into your skin. If you have injections, you'll usually need to have them every two to three months. After having testosterone replacement therapy, you'll be able to maintain an erection and your sex drive will improve.

Side effects associated with this type of treatment are uncommon, and any side effects that you do experience will usually be mild. They may include: oily skin, which can sometimes trigger the onset of acne breast enlargement and swelling a change in normal urinary patterns, such as needing to urinate more frequently or having problems passing urine (caused by an enlarged prostate gland that puts pressure on your bladder) There are also concerns that testosterone replacement may increase the risk of prostate cancer and you should discuss this with your doctor. However, the risks from having testosterone replacement are usually much lower than the benefits of receiving it. Lymph node and lung surgery More advanced cases of testicular cancer may spread to your lymph nodes. Lymph nodes are part of your body's immune system, which helps protect against illness and infection. Lymph node surgery is carried out under general anaesthetic. The lymph nodes in your abdomen are the nodes most likely to need removing. In some cases, the nerves near the lymph nodes can become damaged, which means that rather than ejaculating semen out of your penis during sex or masturbation, the semen instead travels back into your bladder. This is known as retrograde ejaculation .

If you have retrograde ejaculation, you'll still experience the sensation of having an orgasm during ejaculation, but you won't be able to father a child. There are a number of ways of treating retrograde ejaculation, including the use of medicines that strengthen the muscles around the neck of the bladder to prevent the flow of semen into the bladder. Men who want to have children can have sperm taken from their urine for use in artificial insemination or in-vitro fertilisation (IVF) . There are also a number of newer surgical techniques that carry a lower risk of retrograde ejaculation and infertility. These are described below. Some people with testicular cancer have deposits of cancer in their lungs and these may also need to be removed after chemotherapy if they haven't disappeared or reduced sufficiently in size. This type of surgery is also carried out under general anaesthetic and doesn't usually significantly affect breathing in the long-term Nerve-sparing retroperitoneal lymph node dissection A newer type of lymph node surgery, called nerve sparing retroperitoneal lymph node dissection (RPLND), is increasingly being used because it carries a lower risk of causing retrograde ejaculation and infertility.

In nerve-sparing RPLND, the site of the operation is limited to a much smaller area. This means there's less chance of nerve damage occurring. The disadvantage is that the surgery is more technically demanding. Therefore, nerve-sparing RPLND is currently only available at specialist centres that employ surgeons with the required training. Laparoscopic retroperitoneal lymph node dissection Laparoscopic retroperitoneal lymph node dissection (LRPLND) is a type of "keyhole" surgery that can be used to remove the lymph nodes. During LRPLND, the surgeon will make a number of small incisions in your abdomen. An instrument called an endoscope is inserted into one of the incisions. An endoscope is a thin, long, flexible tube with a light and a camera at one end, enabling images of the inside of your body to be relayed to an external television monitor. Small, surgical instruments are passed down the endoscope and can be used to remove the affected lymph nodes. The advantage of LRPLND is that there's less post-operative pain and a quicker recovery time.

Also, as with nerve-sparing RPLND, in LRPLND there's a smaller chance that nerve damage will lead to retrograde ejaculation. However, as LRPLND is a new technique, there's little available evidence regarding the procedure's long-term safety and effectiveness. If you're considering LRPLND, you should understand there are still uncertainties about the safety and effectiveness of the procedure. Radiotherapy Radiotherapy uses high-energy beams of radiation to help destroy cancer cells. Sometimes, seminomas may require radiotherapy after surgery to help prevent the cancer returning. It may also be needed in advanced cases where someone is unable to tolerate the complex chemotherapies that are usually used to treat stage two, three and four testicular cancer. If testicular cancer has spread to your lymph nodes, you may require radiotherapy after a course of chemotherapy. These side effects are usually only temporary and should improve when your treatment is completed. Chemotherapy Chemotherapy uses powerful medicines to kill the malignant (cancerous) cells in your body or stop them multiplying. You may require chemotherapy if you have advanced testicular cancer or it's spread within your body. It's also used to help prevent the cancer returning.

Chemotherapy is commonly used to treat seminomas and non-seminoma tumours. Chemotherapy medicines for testicular cancer are usually injected into a vein. In some cases, a special tube called a central line is used, which stays in a vein throughout your treatment so that you don't have to keep having blood tests or needles placed in a new vein. Sometimes, chemotherapy medicines can attack your body's normal, healthy cells. This is why chemotherapy can have many different side effects. The most common include: vomiting numbness and tingling ( pins and needles ) in your hands and feet kidney damage These side effects are usually only temporary and should improve after you've completed your treatment. Side effects, such as infections that occur when you have a low blood count, can be life-threatening, and it's essential that you always call your cancer care team if you're worried between chemotherapy treatments. Bleomycin One of the medicines commonly used, called bleomycin, can cause long-term lung damage and you should discuss this with your doctors if damage to your lungs would have specific issues for your career or lifestyle. However, the advice may still be that you should receive it for the best chance of a cure.

Having children You shouldn't father children while having chemotherapy and for a year after your treatment has finished. This is because chemotherapy medications can temporarily damage your sperm, increasing your risk of fathering a baby with serious birth defects. Therefore, you'll need to use a reliable method of contraception , such as a condom , during this time. Condoms should also be used during the first 48 hours after having a course of chemotherapy. This is to protect your partner from any potentially harmful effects of the chemotherapy medication in your sperm. Read more about the side effects of chemotherapy . Follow-up Even if your cancer has been completely cured, there's a risk it will return. The risk of your cancer returning will depend on what stage it was at when you were diagnosed and what treatment you've had since. Most recurrences of non-seminoma testicular cancer occur within two years of surgery or completion of chemotherapy. In seminomas, recurrences still occur until three years. Recurrences after three years are rare, occurring in less than 5% of people. Because of the risk of recurrance, you'll need regular tests to check if the cancer has returned.

These include: a physical examination computerised tomography (CT) scan Follow-up and testing is usually recommended depending on the extent of the cancer and the treatment offered. This is usually more frequent in the first year or two but follow-up appointments may last for up to five years. In certain cases, it may be necessary to continue follow-up appointments for 10 years or longer. If the cancer returns following treatment for stage one testicular cancer, and it's diagnosed at an early stage, it will usually be possible to cure it using chemotherapy and possibly also radiotherapy. Some types of recurring testicular cancer have a cure rate of over 95%. Recurrences that occur after previous combination chemotherapy can also be cured, but the chances of this will vary between individuals and you'll need to ask your doctors to discuss this with you. Orchiectomy for Testicular Cancer Orchiectomy for Testicular Cancer Surgery Overview Orchiectomy is the removal of one or both testicles (testes). The testicles are the male sex organs that produce sperm and the male hormone, testosterone . An orchiectomy is a common treatment for testicular cancer .

It may also be done to treat other conditions such as prostate cancer or in the event of severe trauma to one or both testes. When this surgery is done for testicular cancer , it is called a radical inguinal orchiectomy. It is called "radical" because the entire spermatic cord is removed as well as the testicle itself. And it is called "inguinal" because the testicle is removed through a small cut (incision) made in the lower abdomen (groin). During the procedure, after the cut is made, the testicle is pushed up from the scrotum through the incision and removed. The surgery is usually finished in less than an hour. What To Expect After Surgery Orchiectomy can be done as an outpatient procedure or with a short hospital stay. Regular activities are usually resumed within 1 to 2 weeks. And a full recovery can be expected within 2 to 4 weeks. Why It Is Done Orchiectomy is always done when testicular cancer is suspected. This is because testicular lumps are often cancerous and must be removed as part of treatment.

Also, performing a biopsy on a testicle before it is surgically removed can cause cancer cells to spread, making successful treatment more difficult. Sometimes bilateral orchiectomy (removal of both testes) is needed, though this is rare. How Well It Works Orchiectomy is the most effective way to remove cancerous tumors of the testicles. In some cases, orchiectomy is followed by additional surgery to remove cancer that has spread or by other therapies such as chemotherapy or radiation therapy . In some cases of early-stage testicular cancer, orchiectomy is the only treatment needed and is followed only with a surveillance program. Surveillance is a period of time during which your doctor watches you closely with checkups and testing but without using medical treatment. Testicular cancer is a very curable form of cancer , especially if it is diagnosed and treated at an early stage. Orchiectomy is important to the successful treatment of this disease and offers the best chance for cure. Risks Orchiectomy surgery is relatively low-risk, and complications are uncommon. But orchiectomy carries all the risks of any major surgery, including: Reactions to anesthesia or medicines. Infection. Bleeding.

Bilateral orchiectomy (removal of both testes) is rarely done and carries the possibility of side effects. They are related to the loss of testosterone following the removal of both testes. These include: Orchiectomy for Prostate Cancer Orchiectomy for Prostate Cancer Guide Orchiectomy is the removal of the testicles. The penis and the scrotum, the pouch of skin that holds the testicles, are left intact. An orchiectomy is done to stop most of the body's production of testosterone , which prostate cancer usually needs in order to continue growing. Simple orchiectomy is the removal of both testicles through a cut (incision) in the front of the scrotum. If desired, artificial testicles (saline implants) can be put into the scrotum. Subcapsular orchiectomy is the removal of the tissue from the lining of the testicles where testosterone is made. This leaves a nearly normal-looking scrotum. These methods work equally well for stopping the production of testosterone by the testicles. These surgeries are about as complicated as a vasectomy and take less than 30 minutes.

What To Expect After Surgery Orchiectomy can be done as an outpatient procedure or with a short hospital stay. You can typically resume regular activities in 1 to 2 weeks. And you can expect a full recovery in 2 to 4 weeks. Why It Is Done Orchiectomy may help relieve symptoms, prevent complications, and prolong survival for advanced prostate cancer . Radiation treatment is sometimes needed also. How Well It Works Orchidectomy | Topics, Testicular Cancer, Cancer, People's Experiences | healthtalk.org People's Experiences Make collections of pages and videos that interest you. Share your scrapbook or keep it private. Add key words, so that others can find it. Previous Topic | How it affects others Further surgery | Next Topic Orchidectomy When cancer is suspected the best way to confirm the diagnosis is to remove the entire testicle, an operation called an orchidectomy. This is almost always done under general anaesthetic, though can be also be done with an epidural injection. The testicle is removed through an incision in the groin, and then the cells are examined under the microscope. Subsequent treatment will depend on the type of tumour and whether or not it has spread.

Audio only Text only Background: Postal worker; married, 1 child. Well the day I got into the hospital they had to shave me and all this. The wife was there with me all the time, but I have this fear of being put to sleep so I actually stayed awake through the whole operation. You know and I was laughing and joking about with the doctors, I didn't feel a thing. I mean they just said you know "It's gone, off you go." And that was it. You had an epidural? Yeah I had an epidural, which I couldn't actually walk with because it makes your legs go like all jelly, you're all numb down below. And I wanted to go outside and they said "You can go outside when you can stand up," but I couldn't stand up, they was pushing me around in the wheelchair. But as I say I have this fear of being put to sleep and so I wouldn't have it. I mean I said "If you want to take it out you can but I will have to stay awake because I", you know so that was it. I stayed awake and I still had to go to a recovery room for an hour after the operation.

And I mean the operation I think took altogether about 40 minutes. It didn't take that long at all which surprised me. Some men were not clearly informed that they would almost certainly lose the entire testicle. Some were admitted to hospital expecting just to have a biopsy or to have the lump removed. This misconception left these men and their families feeling angry and distressed (see 'Talking to doctors' ). Audio only Text only Background: IT engineer; single, no children. The doctor came round, marked on my left thigh what testicle it was you know that they were going to be operating on. Then a consultant came in, he said that did I know what the operation entailed? I said, "Yes removing the lump." He said, "A radical orchidectomy," I said "No removing the lump," he said "Yeah." My girlfriend commented on the look on my face, when he used radical I knew that it wasn't probably just going to be removing the lump.

So then my doctor came round with a consent form and said, 'Did I have any questions before I signed it?' I said "Yeah one big question that's burning inside me what are you actually going to do?" He said, "We're removing the testicle." And I just looked at him in amazement. And I remembered back to the Monday that I was told that I was going to have the operation and I remember his exact words "We are going to remove the lump." At no point did he say that we are going to remove the testicle. So I sat there in amazement. I signed the form. I wasn't going to go back. I knew that it was the best thing for me. He said that operating on a testicle with a lump on it, if it was cancerous that would encourage the cancer to spread. So I then went on to ask him if it was cancer what would then be the procedure. He said that I'd be asked back in for a CT scan and then obviously further treatment if required. So again I just, it all came to me, it was three hours till the operation and they tell me this. It was not good timing.

It is very rare that cancer occurs in both testicles. However, this can happen. One man describes how he had his left testicle and part of his right testicle removed the first time he had surgery. After chemotherapy, and radiotherapy to the right testicle, he eventually had to have the rest of the right testicle removed too. Audio only Text only Background: Software Development Manager; married, 2 children. Because I had the double orchidectomy, when I woke up I was in quite a bit of pain, just because you can't even favour one side or the other. And that was another thing that surprised me is that nobody said is that the incisions are actually taken on your lower stomach where you'd think if you've got testicular cancer you know you'd go through the scrotum. I, I just assumed that it would be through that, so that surprised me afterwards. So basically you gave him permission to remove both testicles? To do whatever, whatever he thought was necessary and the upshot was that my left testicle was completely removed and my right testicle was partly removed.

The reason for saving part of the organ is to allow the body to continue to generate some hormones otherwise, then you might as well take, take the pair of them off. So he, he was very pleased with his, his work and I then got referred to a cancer specialist at a different hospital. And I think it was about a, about a month from when I first felt ill to when I had surgery for the second time. Which was quite strange. I, I think it, my blood tests were normal, my blood tests were, they had taken a number when I first went to hospital, all the way through and it wasn't until, I think the week before my operation that my cancer markers went up again. And then the week after my operation they went down. So it was quite strange. But that was a, a bit of a shock. The operation itself is usually quite straightforward. It was described as no worse than a hernia or minor knee operation. It may be done as a day case, but men usually stay in hospital overnight. Many of the men were surprised to learn that the testicle would be removed through the groin area. One described the operation in detail. Another man recalled what it was like to have an anaesthetic.

He was pleased that the surgeon had spoken to him immediately after the operation, in the recovery room, reassuring him that the operation had gone well. Audio only Text only Background: Broadcasting; single, no children. So after a, sort of a few hours of sitting about in the waiting area I was taken through for my surgery. It was quite bizarre because I'd never had a general anaesthetic before; I was quite fascinated to see what it would feel like. And it was quite peculiar, I was taken to the sort of preoperative area, spoke to the anaesthetist, we discussed you know allergies, that sort of thing. They, they put a drip in my hand and then took me through to the operating theatre. He was then discussing with me what he was gonna do. He, he injected the anaesthetic into my, into the drip and said 'Just you know, breathe normally,' and I could feel, I could actually feel the anaesthetic actually, it was almost like I was inhaling it, I could feel it in my lungs almost. And then there was just ' You know, lights out.

So I came to some time later, to be honest I'm not entirely sure; I was still quite groggy from the anaesthetic, to be offered tea and toast from the, from one of the nurses. I thought that's a great swap one testicle for some tea and toast! The urologist you know came to see me in the post operative area and said the operation had gone very well, you know she was very pleased with it, with how it had gone and that was quite nice because you know it was nice to see that person so soon after the operation and you know and get that, even just that small nugget of reassurance, just to sort of see you through that initial period after the operation. A few men felt very little discomfort after the operation, and if no more treatment was required, they soon resumed normal activities such as swimming. However, most men experienced some pain and took two or three weeks to fully recover. One man described how he lay on the sofa during the first week after surgery, with his wife 'waiting hand and foot'. Another man explained that he wasn't allowed to lift anything heavy after the operation, and he wasn't allowed to drive for five weeks.

Another man recalled that he was off work for two weeks and was driving after just two weeks. Audio only Text only Background: Quantity surveyor; married, no children. I remember being bent double really up until the Saturday when I went home, I was still walking very slowly. And they tell you not to drive for 2 weeks because obviously the force of breaking [the car] is likely to send a shock wave up your leg; that the first area it hits is your groin. So I was off work for 2 weeks, I remember going into work, probably after the first week, just to have a chat with people really and I was chatting to everybody, it wasn't just the chaps I was chatting to, I was chatting to all the girls, the secretaries and everybody. It was a fairly small company and I knew everybody and I wasn't embarrassed by it. I mean everybody; every chap has got them so why be embarrassed by it. After surgery some men felt that their self-image and feelings of masculinity had been affected, at least for a while (see 'Masculinity and self-image' ). Last reviewed December 2014.

Question: What is removed during an operation called an orchidectomy
Answer: Testicle